PROGNOSTIC FACTORS OF CHRONIC UPPER-LIMB ISCHEMIA AND ENDOSCOPIC THORACIC SYMPATHECTOMY

Long-term results of chronic upper limb ischemia and related prognosti c factors were evaluated. In addition, the efficacy of endoscopic thor acic sympathectomy was examined. Thirty-one patients with chronic isch emic episodes of 41 upper limbs were reviewed retrospectively. The cau se of ischemia included atherosclerosis in 18 limbs, Buerger's disease in 16 limbs, and other causes in seven limbs. Thoracic sympathectomy was undertaken in 21 limbs, and bypass grafting was undertaken in five limbs. Fifteen limbs were not treated surgically. Of the 21 thoracic sympathectomies, the transthoracic approach was used in 12 and thoraco scopy was used in seven. In addition, an extrapleural approach was use d in two cases because of dense pleural adhesion. Compared with open s ympathectomy, the intraoperative blood loss, the duration of chest tub e drainage, and the complication rate were significantly decreased in the endoscopic group. Recurrence rates for all 41 limbs were 14.5% at 1 year, 19.2% at 2 years, and 30.3% at 3 years. Univariate analysis re vealed significantly lower recurrence rates for men, cases caused by B uerger's disease, and limbs without contralateral upper limb ischemia. Multivariate analysis also disclosed a significantly lower recurrence rate for limb ischemia caused by Buerger's disease. The cause of uppe r limb ischemia influenced the outcome. Tn cases of Buerger's disease, the recurrence rates were low, and thoracic sympathectomy was effecti ve. Thoracoscopic sympathectomy was safe and less invasive than open s ympathectomy and is a valid therapeutic option for treating upper limb ischemia.